Financial Clearance Specialist III - Revenue Cycle

UTHealth Houston•Houston, TX

5d•Remote

About The Position

UTHealth Houston is seeking a Financial Clearance Specialist III to join its Revenue Cycle referral team. The position supports the processing of outside-hospital referrals to UTHealth physicians in a high-volume call center environment, serving as a point of contact for referred patients and helping them move from referral to scheduling. The role is remote for employees who permanently reside and work in Texas, with 2–4 weeks of onsite training at 1851 Crosspoint Ave, Houston, TX 77054. The employee must also be able to attend required onsite meetings; lodging and mileage for training are not provided. This advanced-level role is responsible for insurance verification, benefit review, prior authorizations, and referrals to support timely and accurate financial clearance. The specialist resolves complex authorization issues, evaluates medical necessity, and may initiate Peer-to-Peer reviews or appeals for escalated or denied cases. The role also monitors denial and payer trends, supports process improvements, and helps junior staff through guidance and training. The position requires a high school diploma or equivalent. An associate degree in healthcare, business, or a related field is preferred. Five years of experience in insurance authorization, verification, or healthcare financial clearance is preferred; experience resolving complex insurance cases and mentoring or training staff is required. Certification or skills credentials are not specified. This is a security-sensitive position and requires permanent Texas residency and work location.

Requirements

High school diploma or equivalent required.
Experience resolving complex insurance cases and mentoring or training staff required.
Must permanently reside and work in Texas.
Must be able to attend required onsite meetings and complete 2–4 weeks of onsite training.
Ability to exert up to 20 pounds of force occasionally, up to 10 pounds frequently, and a negligible amount constantly to move objects.
Must meet the security-sensitive position requirements described in the posting.

Nice To Haves

Associate degree in healthcare, business, or a related field preferred.
Five years of experience in insurance authorization, verification, or healthcare financial clearance preferred.

Responsibilities

Verify insurance coverage and benefits for referred patients, including reviewing charges and accurately entering patient demographics and insurance details.
Contact patients to obtain and confirm insurance information and communicate coverage, authorization status, financial responsibility, and cost estimates.
Coordinate referrals from external hospitals to UTHealth physicians and support patients through scheduling with their referred doctor.
Secure and document prior authorizations and referrals according to clinical documentation and payer guidelines.
Evaluate insurance policies for medical necessity and initiate Peer-to-Peer reviews or appeals for escalated or denied cases.
Document insurance data accurately in Epic, including validating plan selection using the UT Payor Tool.
Monitor and report trends in denials, payer issues, and workflow gaps, and support process improvements.
Meet or exceed quality, productivity, and turnaround benchmarks established by leadership.
Collaborate with clinical, scheduling, patient access, and administrative teams to resolve insurance or referral issues and coordinate service delivery.
Guide and train junior team members on insurance verification, payer communications, and Epic documentation standards.
Maintain compliance with HOOP policies, HIPAA regulations, payer-specific requirements, and institutional, legal, and accreditation standards.
Perform other duties as assigned.

Benefits

100% paid medical premiums for full-time employees.
Generous time off, including holidays, a preventative leave day, vacation, and sick time, totaling approximately 37–38 days per year.
Additional vacation accrual with longer service.
Monthly longevity payments after two years of service.
Retirement/pension plan.
Free financial and legal counseling.
Free mental health counseling services.
Gym membership discounts and access to wellness programs.
Employee discounts, including entertainment, car rentals, and cell phones.
Resources for child and elder care.